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A Comprehensive Approach to Cardiac Arrhythmia Care

A cardiac arrhythmia happens when electrical impulses in the heart don’t route properly. Successfully addressing an irregular heartbeat happens when you choose the right hospital and medical team that takes a comprehensive approach to treatment – through an experienced team using advanced electrophysiology labs, hybrid ORs and state-of-the-art equipment.

Consistently ranked among the top institutes in the nation, the Jeffrey M. Carlton Heart & Vascular Institute at Hoag has fostered a culture of cardiac excellence that ensures patients experiencing arrhythmias receive precise, tailored care in a patient-centered environment.

Hoag is unlike any other hospital in the region for arrhythmia management, offering the full spectrum of treatment options, paired with the most advanced technology in Orange County, and in some cases, the nation.

“Hoag’s team of cardiologists, electrophysiologists – a cardiologist who has completed extensive fellowship training in heart rhythm disorders – cardiac surgeons, and other specialists provides gold standard and emerging medical management strategies, as well as catheter, surgical and hybrid treatment techniques to help correct cardiac arrhythmias,” said electrophysiologist and cardiology department chair Michael Panutich, M.D.

This team of cardiac specialists is dedicated to outlining the right treatment, for the right patient. What this translates to for patients is a team that works cohesively and confidently for them.

Hoag’s state-of-the-art comprehensive arrhythmia care includes medication therapy, invasive therapies, electrical devices and surgery, including:

Medical Management

The most common treatment option for patients with atrial fibrillation (Afib) is medical management. In this conservative approach medications can be used to control heart rhythm or heart rate. Millions of patient with Afib are treated with a combination of rate control medications, anti-arrhythmic medication, and an oral anticoagulant. Hoag physicians offer great expertise in the field of new oral anticoagulants which are known to be safer and provide significant improvement in the life style of the patients.

Catheter Ablation
A minimally invasive procedure performed in Hoag’s state-of-the-art Allan & Sandy Fainbarg Electrophysiology Cath Lab Suite, catheter ablation aims to modify the heart tissue causing an arrhythmia. During the procedure, an electrophysiologist threads thin, flexible catheters through a vein or artery in the upper thigh to the heart. The physician will perform mapping of the heart to locate areas contributing to the patient’s specific arrhythmia. The catheter emits an energy source that the physician uses to destroy (ablate) a small area of heart tissue that is contributing to the abnormal heart rhythm. Destroying, or rather scarring, this tissue helps restore the heart’s normal rhythm.

Surgical Concomitant Maze
For patients who have atrial fibrillation and who are undergoing surgery for cardiac issues such as coronary artery disease or valve disease, ablation for atrial fibrillation can be performed by a cardiothoracic surgeon in the operating room at the same time to address all the cardiac needs at once. This provides patients with faster recovery and more complete, comprehensive care. Hoag’s specialists are among the most experienced in the region in performing this procedure.

Total Thoracoscopic Maze Procedure

The Total Thoracoscopic Maze procedure is a minimally-invasive surgical procedure for the treatment of atrial fibrillation. It is accomplished through four small incisions about the size of a dime on each side of the chest. Using special instruments, the cardiothoracic surgeon creates ablation lines (scars) on the heart that will block and/or redirect the abnormal electrical impulses. The left atrial appendage may also be excluded with a clip at the same time. Hoag was the first hospital in Orange County to provide this option for the treatment of Afib.

Hybrid Treatment Approach
Hoag is leading the region in this new procedure that combines catheter ablation and minimally invasive surgery for certain patients with persistent or chronic atrial fibrillation. This involves both an electrophysiologist and a cardiothoracic surgeon who work together for this minimally invasive procedure. Through a small incision in the chest, the surgeon ablates the tissue on the back wall of the left atrium from the outside of the beating heart. The left atrial appendage may also be excluded with a clipped at the same time. For the second part of the procedure, an electrophysiologist threads a catheter through a vein to map and ablate other areas inside of the heart known to play a role in atrial fibrillation.

“We feel very fortunate to continue to bring emerging, state-of-the-art treatment techniques to our patients, including the use of this new hybrid approach for atrial fibrillation,” said Anthony Caffarelli, M.D., the Newkirk Family Endowed Chair in Aortic Care and director of Hoag Cardiovascular Surgery and Hoag’s Aortic Center. “Through a continued close partnership between electrophysiologists and cardiac surgeons, patients greatly benefit from more effective treatment methods, and smoother recoveries.”

Left Atrial Appendage Occlusion (LAAO) – Reducing Stroke Risk in Afib Patients

The left atrial appendage (LAA) is a small, appendix-like structure off of the left atrium. In healthy patients, the blood circulates in and out of the left atrium and LAA. For patients with non-valvular atrial fibrillation, non-rhythmic/chaotic impulses cause blood to pool and not completely circulate out of the LAA, leaving a person at an increased risk for stroke. Blood thinners are a common treatment option to reduce this risk, however, some patients cannot tolerate blood thinners and use an alternative technique – closing the left atrial appendage. Left atrial appendage occlusion (LAAO) is done using a transcatheter device or a minimally invasive surgical clip. LAAO is not a treatment option to cure atrial fibrillation, but rather a way to decrease risk of stroke in Afib patients.

Transcatheter Device – The device fits right into the LAA and is designed to permanently close it off and secure existing blood clots. This is a one-time procedure and is completed using a catheter through the groin.

Minimally Invasive Surgical Clip – A clip is another option for permanently closing the LAA, and is completed through minimally invasive access points. Through this minimally invasive surgery, the clip is placed on the LAA, closing off the opening which allows most patients to be off anticoagulations immediately.

In addition to these procedures, Hoag’s Bob & Marjie Bennett Hybrid Cardiovascular Surgical Suite sets the institute apart. No other medical center in the area provides more options for visualization and mapping.

“Hoag has invested in every possible tool to facilitate state-of-the-art care for patients,” Dr. Teferi Mitiku said. “This is important because not all arrhythmias are created equal. Having all the tools needed allows us to make the best decisions for our patients. It speaks volumes about the value the hospital places on quality care.”

Hoag’s Arrhythmia Management Program is offered in Newport Beach and Irvine.